Relation of Proton Pump Inhibitor Use After Percutaneous Coronary Intervention With Drug-Eluting Stents to Outcomes

• Published in: The American journal of cardiology Vol. 105; no. 6; pp. 833 - 838
• Main Authors: Gaglia, Michael A., MD, MSc, Torguson, Rebecca, MPH, Hanna, Nicholas, MD, Gonzalez, Manuel A., MD, MPH, Collins, Sara D., MD, Syed, Asmir I., MD, Ben-Dor, Itsik, MD, Maluenda, Gabriel, MD, Delhaye, Cedric, MD, Wakabayashi, Kohei, MD, Xue, Zhenyi, MS, Suddath, William O., MD, Kent, Kenneth M., MD, PhD, Satler, Lowell F., MD, Pichard, Augusto D., MD, Waksman, Ron, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-03-2010; Elsevier; Elsevier Limited
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Clinical outcomes; Diseases of the cardiovascular system; Drug-Eluting Stents; Female; Gastrointestinal Hemorrhage - prevention & control; Humans; Inhibitor drugs; Male; Medical sciences; Middle Aged; Mortality; Patients; Platelet Aggregation Inhibitors - therapeutic use; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Survival analysis; Survival Rate; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Atherectomy; Prognosis; Angioplasty; Use; Coronary artery; Instrumentation therapy; Circulatory system; Cardiology; Drug eluting stent; Proton pump inhibitor; Percutaneous route
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.10.063

Recent evidence has shown that clopidogrel and proton pump inhibitors (PPIs) are metabolized by the same pathway and that patients taking both drugs have greater levels of platelet reactivity and more adverse outcomes than patients taking only clopidogrel. We sought to examine the effect of a PPI at discharge from the hospital after percutaneous coronary intervention with drug-eluting stents on the incidence of major adverse cardiac events (MACE) at 1 year. We compared 502 patients who were not prescribed a PPI at discharge and 318 patients who were prescribed a PPI. All patients were taking clopidogrel. We followed patients for 1 year with regard to MACE, including death, Q-wave myocardial infarction, target vessel revascularization, and stent thrombosis. We performed multivariate Cox regression to adjust for confounding variables, including compliance with clopidogrel, to assess the effect of a PPI at discharge on the 1-year outcomes. The baseline characteristics of patients discharged with a PPI were similar to those of patients discharged without a PPI. Univariate survival analysis of the outcomes showed a greater rate of MACE (13.8% vs 8.0%, p = 0.008) and overall mortality (4.7% vs 1.8%, p = 0.02) in the PPI group. After multivariate analysis, the adjusted MACE hazard ratio for PPI at discharge was 1.8 (95% confidence interval 1.1 to 2.7, p = 0.01). In conclusion, in patients undergoing percutaneous coronary intervention with drug-eluting stents and receiving clopidogrel, the prescription of a PPI at discharge was associated with a greater rate of MACE at 1 year.